Provider Demographics
NPI:1689638538
Name:ADVANCE ORAL AND MAXILLOFACIAL SURGERY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCE ORAL AND MAXILLOFACIAL SURGERY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAXE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-258-0085
Mailing Address - Street 1:1570 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2956
Mailing Address - Country:US
Mailing Address - Phone:702-258-0085
Mailing Address - Fax:
Practice Address - Street 1:1570 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2956
Practice Address - Country:US
Practice Address - Phone:702-258-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-16
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS220261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDMD220Medicare PIN
NVU34275Medicare UPIN